W2B021K
Dangers petrol-inhaling boys face
If you live in Nairobi or any of the towns, just take a walk one of these days along our major streets. You may see young boys and girls dipping pieces of cloth into car petrol tanks or merely carrying pieces of cloth with which they cover their mouths or noses or bottle from which they inhale.
You might also see them holding polythene paper which they warm and then inhale. You may just overlook it as just a mere fun for them. What indeed they are doing is that they are inhaling petrol from those pieces of cloth and the bottles they hold to their mouths or noses or are having some kind of glue held in that polythene bag and are smoking the glue vapour. They are inhaling what is known generally as volatile solvents.
You may wonder how those kids got to know about it, considering that they do not really travel far. But they are part of a growing problem, found all over the world, of people who have turned to solvents as drugs of abuse.
Among the volatile solvents are petrol, varnish remover, glue and aerosols, especially spray paints. All these substances have certain biochemical substances in common, namely toluene, acetone, benzene and so called halogenated hydrocarbons.
Petrol in amounts enough for their purpose and glue are widely available from <-/left overs> and therefore, they do not have to spend any money to have access to them. These youths are usually so poor that they cannot afford to spend money on any other drug of abuse.
Intoxication effects often come on within five minutes, and usually last 15-30 minutes. The solvents produce a central nervous effect, characterised by euphoria (a sense of well being) excitement, a floating sensation, dizziness, slurred speech, ataxia (uncoordinated gait) and a sense of heightened power.
It is usually for these effects that the youths inhale the vapour of solvents, particularly the euphoria and a sense of heightened power.
But these are not the only possible effects. There are others which are dangerous and/or not required. These include apathy, diminished social and occupational function and impaired judgement leading to impulse and aggressive behaviour, nausea, acute loss of appetite, uncoordinated side to side eye movements (<-/nystagmus>), seeing double (diplopia) or blurred vision.
With high doses confusion and unconsciousness can develop. Death may occur in very high doses because of interference with that part of the brain that controls breathing. Inhalants often leave visible external evidence, such as a rash around the nose and mouth, and smell of the breath, irritation of the eyes is common. So is irritation of the throat, nose and lungs.
It is not clear whether there is a withdrawal reaction and most youths can stop the habit without developing any withdrawal symptoms. It does not cause dependence.
However, if they continue to inhale for a long time, they may find that they need to inhale more and more to get the desired effects. Substantial tolerance develops after repeated sniffing.
With continued use, there is the serious risk of irreversible damage to the liver, kidney and other organs, particularly by the compounds benzene and hydrocarbons which are some of the active ingredients of these solvents as mentioned earlier on.
Damage to the peripheral nerves - nerves outside the brain and the spinal cord (so called peripheral neutitis) - has also been reported.
Permanent damage to the muscles and also brain damage is possible because such inhalants often contain high concentration of copper, zinc and heavy metals which are known to damage muscles and the brain, particularly in solvents containing toluene, one of the ingredients of the solvents.
The so called super or premium petrol brands contain lead, a poisonous metal.
Most people will probably have heard of a group of drugs known as benzodiazepines. They were first introduced into clinical medicine in the 1960's. There are now well over 20 drugs that belong to this group. It may not be proper to use the trade names, although they are best known by either their trade names or the companies that make them. This may give the wrong impression about those otherwise very good medicines, and extremely highly professional companies who have made such immeasurable contribution  to mental health in this country and the world in general.
Perhaps the best known scientific name for this group of drugs is diazepam, but as stated earlier, there are well over 20 other preparations and although similar, are different in their trade names.
In good hands, these are some of the most important drugs we have. But unfortunately, there are people who are now increasingly using them for abuse. One popular way of doing this is to lace <ea/>changaa with it.
Diazepams  are extremely cheap medicines, probably far much cheaper than a mug of <ea/>changaa. For one tablet of diazepam, 2 mg could on wholesale price cost less than four cents. But if you add diazepam to <ea/>changaa or to any other illicit drink, it makes it more potent and therefore you can sell less for the same desired effects.
Many people will have heard people who get robbed on buses or trains after accepting food from a rather friendly fellow traveller.
Such people fall asleep so deeply that they are robbed in their sleep and indeed are still deeply asleep by the time they reach their destination.
It may be that a benzodiazepine is used to lace those drinks and foods. Some of the benzodiazepines are so <-/totent> that they can make you sleep for many hours and be so sleepy that even beating you is not going to wake you up.
These people find themselves increasingly taking higher and higher doses to achieve the same desired effect that they cannot do without the drugs. 
Behavioural disorders in children
All of us, regardless of our social status or our roles in society, as parents, family members, teachers, or just ordinary members of the society, deeply appreciate the virtues of a child who is well behaved. Parents are extremely proud of their well behaved children, and so are teachers. Although it is not so easy to define a well behaved child, such descriptions as obedient, polite, kind, considerate of others, unselfish, <-/respectiful>, viceless, hard working, etc are some of the descriptions associated with well behaved children.
Badly behaved or bad-mannered children not only attract the opposite of the above descriptive words, but also such words as  aggressive, abusive, liars, stealing, fighting, unreliable, dangerous and so forth. Their behaviour can be described as disruptive or anti-social, in the sense that they do things that are generally against what the society generally considers "normal" or acceptable. There are many children who by their behaviour easily qualify for the descriptions of anti-social and disruptive. These children are not only the concern of their families and their teachers, but also the society at large. In the course of this discussion we will examine this issue in some detail. For the purposes of our discussion we will group these disruptive behaviours into three categories:
* Conduct disorders
* Attention - deficit hyperactive disorder (so called the hyperkinetic syndrome) and
* the oppositional, defiant disorder.
Because of the importance of these problems to families, the schools and the society they will be described in details . We will define each one of them, describe its clinical features, causes and possible management.
First the conduct disorder. The essential feature of a conduct disorder is a repetitive and persistent pattern of conduct (behaviour) in which either the basic rights of others or major age - appropriate societal norms or rules are violated. The conduct is more serious than the ordinary mischief and pranks of children and adolescents. The diagnosis of conduct disorder can only apply to children who are less the age at which they can be considered responsible and punishable by law for their <-_misconducts><+_misconduct>.
The <-_misconducts><+_misconduct> that qualify a child for conduct disorder are numerous and some of them were listed earlier on this discussion . They include stealing without confrontation, or forgery on more than one occasion, running away and staying away from home against the wish of the parents. Often he plays truancy  from school, has broken <-_peoples><+_people's> property, such as breaking into a house or car, has deliberately destroyed other <-_peoples><+_people's> property, is generally cruel, often initiates physical fights or has used a weapon such as a knife to fight, physical cruelty to other people , has stolen by confronting of a victim , for example mugging, purse-snatching, <-/exortation>, robbery. The more one has of these (upwards of six) and the longer they have been there (upwards of six months) then the more serious the conduct disorder is.
Conduct disorders as so far described are fairly common during childhood and adolescence. They are more common in boys than in girls with ratios ranging from four to one to 12 to one. Conduct disorder is more common in children of parents with anti-social personality, and alcohol dependence than it is in the general population.
The prevalence of conduct disorder and antisocial behaviour is also significantly related to various socio-economic factors. There is no single factor that can account for children's anti-social behaviour and conduct disorder. Rather a variety of biological, psychological and social factors contribute to its development.
Parental factors have been extensively studied in relation to conduct disorders. It has long been recognised that certain parental attitudes and faulty child-rearing practices influence the development of children's <-/maladaptive> <-_behaviours><+_behaviour>. Chaotic home conditions are associated with conduct disorder and delinquency. It is important to emphasise that it is not merely a broken home that is the cause but rather the strife between the parents that contributes to conduct disorders. As much as parents want to stay together for the sake of children, their strife should not be the order of the day to the extent that the children are a witness to it.
If a disagreeing couple want to stay together for the sake of children then that staying together must be peaceful if it is going to serve the purpose. As much as we all like to keep families together, that togetherness will be of value to the children if the strife is kept out of the eyes of the children  otherwise it will achieve just the opposite of the desired effects. Parental psychiatric disorders, such as antisocial behaviour on their part, and addictive behaviour such as alcohol dependence are important casual factors.
Socio-economically deprived children, unable to achieve status and obtain material goods through legitimate routes may be forced to resort to socially unacceptable means to achieve these goals. If children are brought up with other children who because of their upbringing are prone to <-_these><+_this> anti-social behaviour, then the peer pressure may be so much that they succumb.
Harsh, inconsistent, physically enforced discipline in early childhood, cruelty to children in their early years or even outright rejection by their parents, whether biological parents, step parents, foster-parents or relatives are all factors that can predispose children towards anti-social behaviours.
Isolated <-_act><+_acts> of anti-social behaviour do not justify a diagnosis of conduct disorder. Rather anti-social behaviour should be repetitive and persistent for a period of six months or more to justify a diagnosis of conduct disorder. Conduct disorders should be differentiated from other problems that resemble it. These are oppositional defiant disorder, the hyperkinetic syndrome, and manic illness in children. These will become clearer when they are described in the course of this series. But briefly in oppositional defiant disorder, the child does not violate the basic rights of others and major age appropriate societal norms or rules.
The essential feature of oppositional defiant disorder is a pattern of negativistic hostile and defiant behaviour, often directed towards parents or teachers. Otherwise the affected children do not fight, lie, steal or indeed interfere with anybody's rights. They are just outright defiant. In hyperkinetic syndrome the problem is one of poor ability to concentrate and the culprits are irritable and their attention - span is very limited. 
W2B022K
Institute wins a battle over maize streak virus
The Kenya Agricultural Research Institute (KARI), once considered a sleeping giant, has undergone major positive changes in the last three years and the trend is bound to continue unless the much deserved support - financial and material - is curtailed.
KARI, ranked as one of the largest national agricultural research institutes in Africa, is also clearly one of the few in the world that could be directly sustained and improved by the "products" of its work. It has helped the country boost pyrethrum output, curb the spread of the deadly cassava pests invading the country from Tanzania, and introduced many other innovations which can only be listed in a booklet.
However, KARI's most dramatic achievement has been in boosting maize production. Indeed, during the last three years, the country's agricultural production has been heading for a disaster because of the emergence of maize streak disease reducing yields by 20 per cent, and up to 50 per cent in central and coastal parts.
There were even talks of "bad" seeds having been given to farmers who, like most local experts, did not know how to deal with the situation. The disease is caused by maize streak virus (MSV), first detected in Kenya in 1936. At that time, its presence in different parts of the country was negligible.
This changed in 1988 when major outbreaks of the disease, which kills or stunts maize growth, were reported in Central and Coast provinces.
"This disease has the potential to wipe out all our achievements in raising maize production and we just had to deal with it," the KARI director, Dr C. Ndiritu, told the Nation during an interview at the new KARI headquarters off Waiyaki road in Nairobi.
He said that "although it is true that our researchers have identified local maize varieties that are resistant to the streak disease, there is an urgent need to remind farmers that the maize can be controlled and the information is in our free bulletin produced last year."
The seeds from resistant varieties being developed by KARI researchers may be available to farmers in two to three years and this makes it necessary to inform our farmers about the alternative control <-/medthods> before the long rains begin, he added.
The disease is caused by the MSV carried by an aphid (Cicadutina spp) which is also referred to as a leafhopper. It must be remembered that our cypress forests are threatened by another type of aphid," he said.
Some of the preventive and control measures listed by KARI include:-
* Planting early in the season before peaking of the leafhopper or aphid population.
* Crop rotation, for example of maize followed by Irish potatoes or maize followed by beans. In other words maize should be rotated with crops that do not host both the virus and the leafhopper.
Inter-cropping may reduce the leafhopper's ability to locate maize which is the host plant. 
* Farmers should avoid continuous planting of maize and there should be a period of rest or fallow. Continuous planting creates an ideal condition for spread of the maize streak disease.
There are also chemical control methods, including the use of insecticides at planting time. Dr Ndiritu said plants are most susceptible when young and insecticides like Carbofuran give effective control for about four weeks when applied at a rate of 20 grams per 100-metre row.
However, Dr Ndiritu said that the chemical is expensive and should be only used where the disease level is always very high and there are also other chemicals.
Maize streak virus stops its damage when transmitted after nine weeks after germination and the control should be limited to this period. The. KARI director also said that the biological control of the cassava mealybug in Muhuru Bay in South Nyanza appears to be effective.
"I don't agree with those who assume that biological controls can not be effective and KARI only resorts to these after thorough consultations and research work," he said. KARI collaborated with the International Institute of Tropical Agriculture (IITA) based in Nigeria.
However, the hottest thing from KARI has been the publication of its research paper on The Impact of Research In Maize Yields in Kenya from 1955 to 1988.
This is the first paper of its kind in Kenya and the fourth in Africa according to ISNAR (International Services for National Agricultural Research).
The paper may sound uncomplicated and ordinary, but the greatest problem facing practically all policy makers, administrators and research institutions in developing nations is lack of tangible data and information indicating the output or profits derived from successful research activities.
Still, most scientists fail to link economics with their work although things are changing rapidly as economists also attempt to understand and recognise science as the driving force behind sustainable development.
The paper by researchers D.D. Karanja and A.G.O. Okech was presented during KARI's review workshop held in Kakamaga from November 19 to 23 last year.
It says that maize research in Kenya started in Njoro in 1930 but the programme was abandoned until 1955 when a more systematic maize improvement programme began in Kitale.
The Kitale work aimed at <-/ploducing> late maturin ghybrids (six to eight months) for areas with rainfall of 750-2000 mm. Between 1966 to 1989, at least 11 high altitude maize hybrids were developed and released to farmers.
Katumani maize improvement activities started in 1956 to develop varieties suitable for regions with low and unpredictable rainfall ranging between 250-400 mm.
Thus, early maturing varieties were developed and Katumani composite A and B were developed in 1966 and 1968 respectively.
However, a major breakthrough for improved maize production in semi-arid occurred in 1986 when the Dryland Composite I (DC 1) was released to farmers. The variety flowers earlier and is higher yielding than the above two varieties mentioned above. The DC I can survive in areas with only two months of rainfall.
Research into medium maturity maize (five to six months) began at Embu in 1965 for areas with 350-750 mm. These varieties were developed by breeding Kitale late-maturity hybrids and Katumani early maturity ones. This resulted in two varieties released in 1968 and 1970.
Dr Ndiritu told the Nation that the rate of return, when it comes to maize research. is at least 41 times higher than the input. We have not only developed high yielding hybrids but we have determined fertiliser use, pest control and other factors which, if followed by farmers, definitely boosts their incomes.
KARI is already establishing an ambitious computerisation programme that is making the gigantic institute with numerous centres scattered in the country easy to manage. The Nation visited some its computer facilities  that make it easy to account for its assets. However, and even more encouraging, is its increased ability to publish <-/informatin> using desk-top facilities. 
Science and Technology
Easing the pain of mental sickness
Despite the many conventional health problems it has to tackle, the Ministry of Health is intensifying its services to mental patients who are still feared, hated and ignored by most Kenyans.
Kenya, unlike many other countries with equally meagre resources, has added mental and dental health to the eight basic ingredients of primary health care in the quest for health for all by the year 2000. The country's plan includes integrating these into all its primary health care activities.
However, when it comes to mental health, things seem to have been slow and most observers had assumed that its inclusion into mainstream of the primary health delivery system may have been merely for prestige. 
But things seem to be changing. In the last two years, the Director of Medical Services, Professor J. Oliech, has been talking a lot about the need for Kenyans to take matters of their mental well-being seriously and avoid primitive fears and stereotypes that make many people avoid seeking solutions to their mental problems.
Prof Oliech made his intention clear by ensuring that he was accompanied by Dr Willy Muya, who is in charge of mental health services, whenever he went for functions round the country.
In the last two months, the Minister for Health, Mr Mwai Kibaki, the Permanent Secretary, Mr Daniel Mbiti and other top Ministry officials have intensified their efforts to preach the gospel of better mental health for all Kenyans.
Parliament enacted a new Mental Health Act in 1989 but its implementation begins on May 1. This may be another factor behind the intensity of recent campaigns to educate and inform Kenyans about the importance of their mental health.
The most important aspect of the Act is that it discourages the classification of mental health issues as crimes. Yes, according to Kenyan laws which had their roots in the prejudices of the colonial area, mental patients had to be arrested and taken to court for committal to mental hospitals.
Mental patients were <-/inhumanly> treated and were often considered worse than criminals. Few people sympathised with them. Indeed, most Kenyans simply wished them death <idiom>. Stories of <-/metal> patients being beaten and chained to beds are common. From Mathare Mental Hospital we heard stories of patients being whipped or beaten mercilessly to ascertain their abnormality.
However, since some criminals claim to have been influenced by temporary insanity while committing crimes, mental patients have not yet got away from never ceased being considered  inseparable from real criminals. The fact that mental patients were supposed to be arrested and taken to court for committal to mental hospitals made matters worse. (repetition of part of last paragraph but one)
However, the rapid increase in information and knowledge within the biomedical sciences, especially the nervous and hormonal system, clearly indicates that practically everybody has or develops some form of mental problem during their lives and it is the only the  degree of the problem and the ability to cope with it that matters.
The linkage between mental problems and the socio-economic-cultural environment is always there. However, biomedical research is opening new frontiers that may result in better management and treatment of mental patients.
The Mental Health Act aims at decentralising mental services to the district level. However, the few psychiatrists, psychologists and even neurologists in Kenya and other developing nations are still treated as outsiders in the medical field; they are not supposed to deal with those having "real" diseases.
The issue is complex because even the health insurance industry keeps off mental patients by avoiding paying claims linked to mental problems. How much do we know about mental health? What exactly are medical problems? Who gets them? These are some of the issues will be examine  in the coming weeks. 
Science
Amref's war against malaria
Although much is being said about malaria and its control, there is still need to examine various aspects of the disease which may hinder its effective control and treatment.
Experts from African nations will soon meet at the World Health Organisation Africa regional headquarters in Brazzaville, Congo, to examine how best the disease can be controlled. However, for those who monitor such conferences, there is little that is achieved beyond resolutions and planning for more meetings.
<-_African><+_Africa> needs action to control malaria. The disease has continued to spread because there is very little being done beyond conferences which, in any case, ignore the fact that the information that is already available can be used to solve the problem.
As said in the last article, large scale operations to control malaria seem to be ended soon after the independence of many African states. The emergence of primary health care programmes aiming to make communities, families and individuals self reliant in controlling diseases, provides hope in the war against this major killer.
Thus, more support should be given to non-governmental organisations that are directly or indirectly helping communities control the incidence of malaria which has a heavy toll on children and women.
Among the institutions attempting to help control malaria in Kenya and other eastern Africa nations is the African Medical Research Foundation which has its headquarters at Wilson Airport in Nairobi.
W2B023K
The effect of herbs on pregnant women
Traditional medicine forms part of the African setting. Kenyan communities are no exception and most of them still have strong attachment and belief in herbal medicine.
So far 75 per cent of doctors are in the urban centres where only 10 per cent of the total population lives. At the same time only 25 per cent of all deliveries in the country are conducted in hospitals.
Stronger beliefs however can be found in certain parts including, Western Kenya, South Nyanza, the coastal region and North eastern provinces.
A recent study has however expressed concern over the use of herbs by pregnant women.
The study carried out in Mombasa General Hospital shows that a substantial number of pregnant Mijikenda women still take various herbs for various reasons.
The content of the herbs, the dosage, the reasons why they are taken and the effects on the foetus is what motivated three gynaecologists to do the study.
But there is also a theory that has indicated that some of the herbs taken by expecting women could have fatal effects on the baby and the mother.
Presenting a paper to the just ended 16th annual conference for the Kenya Obstetrical and Gynaecological Society, Dr Ominde Ochola outlined several herbs taken and the reasons behind it. These include what is known in Mijikenda language as <ea/>shango, <ea/>muarubaini (azadirachita indica), <ea/>sakani <ea/>mnakivundo (sophora inhambanensis), <ea/>kivumbani (ocimum basilicum), <ea/>ukwaju (tamarind), among others. Some of the botanical names are unknown and so are the contents of the herbs.
The study which he carried out with Prof Andrea Makokha and Dr Karanja, showed that the women took more herbs in the first phase of the pregnancy. This was because they believed the herbs would facilitate growth of the baby, avoid miscarriage and would help them get the desired sex. But they also took in the second phase as anti-infection remedies and in the last three months to control anaemia, prevent toxaemia, correct malpositioning of the foetus and initiating labour. Others take the herbs to avoid hallucinations bad omen and evil spirits, the study found out.
But those who administered the herbs were not necessarily qualified to do so. Hence the concern for the whole procedure.
Says Dr Achola: "Some of the traditional practitioners are no more than quacks and their unskilled use of the herbs coupled with unhygienic procedures culminate in increased morbidity and mortality for both mother and child.
Indeed those who administered the herbs ranged from witchdoctors, healers, relatives and traditional birth attendants while the beneficiaries included women of all ages and their religion or level of education did not hinder them from taking the herbs. Over half of the users were Christians.
A good number of the women did not know what they were taking.
Most of the women also went to the conventional clinics, which indicated that they took the herbs to compliment the conventional services.
Some of the women interviewed said they had <slang/>gotten relief from pain. But others did not.
One woman who had taken the herbs gave birth to a child with a congenital <-/anormally> while two others died of <-/aenemia> complicated by post-partum haemorrhage and another of celebral malaria. Some had lost their children earlier due to childhood diseases.
A substantial number had spontaneous vertex deliveries and the babies were alive. The two had still births and had taken herbs during the first semester of the pregnancy. One of these two was a marcerated still birth. Two other still births were from a <-/cesarean> section.
Although there were all these indications, the doctors say they have not yet established the interference of the herbal medicine in the <-/fetal> well-being.
"But there has been a theory that herbs could affect the functioning of the placenta and the development of the baby," Prof Makokha says.
Some herbs are said to have a high level of toxicity and that they could lead to a rupturing of the uterus.
"We want to analyse the content of these herbs and to know the long term impact, on the development of the child while still in the womb or later".
But while herbs may pose a threat, pollutants have also been cited to affect expecting mothers.
According to Dr Otmar Bayer of the University of Bonn, Germany, insecticides, lubricants and pesticides were cited in India in the early eighties to influence infertility and to cause abortion.
He told the conference that some chemicals are known to remain in the body for 30 years after they get into the body. They are normally deposited in the fatty tissues of the body.
He says the latter reasons have necessitated European countries to ban the use of these chemicals which have been proven to cause infertility in animals, especially birds which have come into contact with them. This is through eating plants that have been treated with the chemicals.
Some of the chemicals include, DDT, dieldrine, HCB. and HCH.
His study which contained a comparison between his country and Tanzania has however not confirmed this fear.
"We haven't proved any of these theories right, but our major concern is the <-/>the long-term impact on humans," he said.
He said the study had shown that the chemical burden in people in Tanzania was ten-fold that of the study group in Germany.
"Nobody knows whether these will have an effect on human chromosomes in the long run but the most unfortunate thing is that despite the ban in Europe, these companies are still selling them to the tropical countries," he said. 
Fibroids: The painful lumps that grow in so many women
Her mother lost two pregnancies in the late 1950s, her four sisters have all had an encounter with fibroids, while she has had two operations to remove the growths. Now her two nieces have fibroids and the family is wondering what this is all about.
Nancy Wanjiku, 40, a mother of two, recounts how in the late 1970s she went through a persistent abdominal and back discomfort.
She was then 25. It soon led to severe stomach cramps then sporadic bleeding.
She soon learnt she had some growth in the lining of the uterus, which made her situation worse.
"I was so distressed and confused because I feared that the growth in my uterus was cancerous," she reminisces.
Two years later the doctor recommended an operation and while at it, he removed one of fallopian tubes because it was also affected.
"It really felt awful, particularly because I had been longing to have a baby," she says.
"The removal of the tube only made my chances of conception less, you know."
Years later she was rewarded but the fibroids grew again, causing her to lose the pregnancy at five months.
"You can't believe it but the fibroids were larger than the baby," she says.
She gave up hope of ever getting a baby but two years later, in 1992, she was overjoyed to find out that she was pregnant. She got herself a son ... and another one last year.
"I thought those babies were a big miracle because I had given up on ever having a child of my own," she says.
Wanjiku now says she does not worry about fibroids any more although she knows they could recur any time.
"I now quietly monitor the symptoms and would know immediately if they started but as long as I am comfortable right now I am not worried."
What amazes Wanjiku and the family is that the problem of fibroids seems to be hereditary.
She explains that her 55-year-old sister who had all her five children by the time she was 24 also has fibroids. She has, however, refused to have them removed. "But her 29-year-old daughter has already lost a pregnancy and has had an operation to remove them.
One of Wanjiku's other sisters lost three pregnancies, had an operation to remove the fibroids but has not been able to conceive.
But what are fibroids And why do so many women seem to have them today? Is there an increase in their occurrence, and do they run in families?
Dr Stephen Ochiel, a city gynaecologist, explains that fibroids are uterine muscle growths that tend to grow in women of over 35 years of age, but which tend to start earlier in black people. Science is yet to explain why they are more common among black women than other races.
"I have seen 17 and 18-year olds get it," he says.
The causes are not known but Dr Ochiel says the growths, which are almost always benign, not cancerous, are commonest among women without children or those with few children. Those who postpone birth also seem to be more prone to the growths, he says.
He explains that fibroids are so common that 20 per cent of women who die in the world of other causes are found to have them.
"This means that one out of every five women has fibroids."
Very rarely are they malignant, he adds.
However, most women who have fibroid growths do not complain of it because most of the time these do <-_no><+_not> manifest any symptoms.
"For as long as they show no symptoms, a woman need not worry about them," he says.
Those who have gone through an experience like Wanjiku, however, say the fibroid growths can be very painful and stressful.
"You just get this pain in the uterus that increases with the monthly flow," explains Millicent Ngina, 40, and a secretary. She learnt that she had fibroids almost a year after she had noticed the symptoms.
It started with her menstruation becoming regular and heavy, and with time had an extra day of flow every month.
"Soon there was intense pain as this flow increased and my stomach started feeling bulky," she says.
But the worst was yet to come as the doctor diagnosed fibroids and suggested that her uterus be removed.
"It hit me like a bomb," she says. "I just could not understand the possibility of living without a uterus," she says.
The doctor had advised her to make a decision since he felt removing it was the best solution. He, however, gave her an option of waiting until menopause (a few years away) before it could be removed.
"But I required very strong drugs for the pain and it made me very uncomfortable". 
After a few months of dilemma and soul-searching she decided to have it removed because "I thought I was not going to have any more children anyway." She already had two teenage children.
The symptoms include abnormal uterine bleeding, irregular periods which could be progressive over time, occasional severe pain in the uterus, painful sexual intercourse and the growth of the tummy.
Fibroids can grow on the outer surface of the uterus, within the uterine wall or under the surface.
Depending on the position, they can cause miscarriages, abnormal or premature labour, obstruct labour, cause unco-ordinated uterine contractions, damage or stretch the fallopian tubes. They can also distort the uterine cavity.
"Sometimes a fibroid may grow right where a baby should be," Dr Ochiel says.
But the fibroid growth may not necessarily grow in only one place. "Sometimes they grow in many places in the uterus," he adds.
He rules out the impression that nowadays, there are more cases of women with fibroid growths and attributes this to the fact that today, women are more aware of their health and have expert advice more readily available than ever before.
"We also have faster ways of detecting these growths," he says.
But whether they run in families and are therefore genetic is yet to be proven, he adds.
"We know that they are the commonest growths in women and the commonest cause for removal of the uterus." 
W2B024K
The abortion question
Out of 155 parents and prospective parents interviewed on what they would do if they discovered their school-going daughters were pregnant, 40 replied they would make arrangements to terminate the pregnancies. Raphael Kahaso poses a few questions on the Education Act and interviews a counsellor in one of the three homes for counselling pregnant girls.
Take 10,000 girls aged between 12 and 18 years and imagine what would happen to them at the end of the school circle. Some would become doctors, nurses, teachers and others architects, engineers. lawyers, secretaries, journalists etc etc.
But come to think of it. This is the number of girls who are forced out of school every year when it is discovered that they are pregnant.
And what happens when these girls, some of them too young to take care of themselves? A very small number find their way back to the classroom after delivering while the majority either get married to the men responsible or end up in the streets. "Just imagine losing 10,000 brains - some of the best we have to pregnancy," posed a young couple who participated in a <-/questioneer> on what they would do if their daughter became pregnant and was in danger of losing her place in school.
The couple were among 155 people from all walks of life who replied to the <-/questioneer>. Everyone of them except 11 knew what they would do if they discovered that their daughters were pregnant.
Of the 155 interviewed, 78 (50.32 per cent) said they would withdraw their daughters from school, keep them comfortable at home until they delivered and then look for an alternative school.
They would also take them (girls) for counselling while they wait to deliver.
But 40 of those who were covered in the survey (25.8 per cent) said they would opt to have their daughters' pregnancies terminated if they discovered them in the first three months. "I would not let the education of my daughter suffer because of a stupid pregnancy," said a 45-year-old career woman who added that modern ways of abortion have a 99 per cent chance of success.
The survey covered both men and women between the ages of 20 and 60. Some of these were not yet married but they indicated that if it happened to their daughters in future they would not change their mind.
Only 12 of the 155 people said they would try to force the people who were responsible for the <-/prenancies> to take responsibility including taking legal action against them.
Those who would not bother to look for other schools for their daughters if they became pregnant were 13 or 7.7 per cent of the people interviewed. These said they would look for vocational training for their daughters.
The fact that 40 of those interviewed said they would go to the extent of terminating the pregnancies of their daughters to save them from being chased out of school implies the importance that Kenyans attach to education.
Every school in Kenya maintains that when a girl becomes pregnant she becomes a bad example to the rest and is chased out of school. Those who become pregnant during the final year after paying examination fees are allowed to return to school for the examinations only.
The Education Act, however, is silent on the issue of girls becoming pregnant and several of the 155 interviewed said they would want to see the act revised to take care of "children who get children".
Of those who replied that they would allow their daughters to deliver at home and continue schooling included two men aged between 50 and 60 years, four women aged between 50 and 60 years, 12 men aged between 40 and 50 and 10 women aged between 40 and 50 years.
Others were 12 men aged between 30 and 40 years, ten women aged between 40 and 50 years and surprisingly ten men and 13 women aged between 20 and 30.
Those who said they favoured termination included ten men and ten women aged between 20 and 30 years, four men aged between 50 and 60 years, four women aged between 40 and 50 years and nine men and women aged between 30 and 40 years.
Although the people covered in the survey are working and residing in Nairobi, nearly half of them have their families in the rural areas and their views may be shared by some of those in the rural areas.
Abortion is illegal in this country. All we hear about abortion is when something goes wrong, like when a doctor or a boyfriend of a pregnant girl are taken to court for assisting a girl to induce an abortion or when a girl dies of an overdose of drugs while trying to abort.
Although many of the 40 people interviewed said they had an idea what an abortion entailed, some said they only had vague ideas about it.
During the first three months of pregnancy, the most used form of abortion is suction-curettage. The first step is to force open the tightly-closed muscle at the mouth of the uterus with a series of metal <-_roads><+_rods> called dilators.
The abortionist then uses a suction curette which is attached to a powerful vacuum to scrape and pull the foetus from the walls of the uterus. A curette (a sharp, spoon shaped knife) is then passed over the inside of the uterus to make sure it is clear.
After 12 weeks four different types of abortion may be used: D & C (Dilation and evacuation) in this one, the abortionist forces the cervix open; then he alternates between cutting the foetus and the vacuuming it out of the uterus. The skull must be crushed with forceps and pulled out carefully so that the bone does not cut the mother. This form is used between 12 and 18 weeks. Saline - A strong salt solution is injected through the mother's belly into the sac of fluid surrounding the child. This begins a slow poisoning and burning process in which the child may take many hours to die. The mother then goes into labour and delivers the dead baby.
Prostaglandin - This is a drug which causes violent <-_contraceptions><+_contractions> so that the mother delivers prematurely. The child usually dies in the process, but is sometimes born alive and a decision must be made about whether to begin life-support procedures.
<-/Hysterotomy> - (usually done when other methods fail). The abortionist cuts through the stomach and uterus of the mother and removes the live baby. The baby is then allowed to die through neglect.
But before a parent decides that the best option is to terminate the pregnancy of his daughter, he should make a point to visit the Crisis Pregnancy Ministries Centre for first hand information about abortion.
Some 60 per cent of the women (including girls who visit the centre) for counselling are already decided on abortion. But by the end of the counselling sessions (which are free) less than 20 per cent go ahead with the abortion.
The counselling sessions cover such subjects like abortion and its risks, the biblical basis about the sanctity of human life, the physical effects of abortion and the emotional effects. Also covered is the subject of adoption.
But if the girl makes up her mind about abortion, she is still welcome back for a post-abortion counselling which includes bible study sessions on healing and forgiveness. Where the girl decides to have her abortion is not the concern of the centre which totally likens abortion with murder.
"I believe we can counsel the parents who would opt to have their daughters abort," said Karen Erickson, a missionary at the Crisis Pregnancy Ministries Centre at Westlands.
The centre also provides a place to sleep for the pregnant girl if necessary, provides maternity dresses and assistance to pay hospital bill at delivery.
Other centres which provide similar counselling services including trade courses and adoption services include the Maria House in Eastleigh and Jamaa Home near Jericho Estate.
Maria House provides transport to counselling sessions to the pregnant girls and pays half the hospital fee at delivery.
Some of the complications that may arise out of an abortion may include excessive bleeding that can result in the removal of the uterus. This, of course, leaves the girl or woman unable to bear children.
Other complications are a possible puncture of the womb which will also result in the removal of the uterus, infections which may range from mild to fatal, guilt and personality disturbances. Future pregnancies can result in miscarriages, premature deliveries and tubal pregnancies.
Crisis Pregnancy Ministries Centre says it is important to realise that:
* One week after the girl misses her period, the foetus heart starts beating. (If she has conceived).
* Two or three weeks after the girl missed her first period, the foetus inside her has a brain, eyes, ears, mouth, kidneys etc.
* The baby's brainwaves can be measured by the time the girl is eight weeks pregnant.
* When the girl is 12 weeks pregnant, the foetus can grasp an object placed in his hand-and make a <-_first><+_fist>.
* The baby's hands, complete with fingerprints, are formed before 12 weeks of pregnancy. 
God, here I come
Cancer patients whose illness has reached a stage at which there is no longer hope for cure and that death may be close should not be left to die in pain, Raphael Kahaso reports.
An eleven-year-old child walks into the Nairobi Hospice at the Kenyatta General Hospital accompanied by his parents. As they sit down to wait for their turn to see the doctor, they chat happily glancing now and then at the door to the consultation room.
When their turn to see the doctor comes, the boy struggles to stand up. He is assisted by the parents and they walk to the consultation room.
Dr Anne Merriman examines the boy, asks a few questions and writes down the prescription. The father goes to the Hospice's pharmacy to get the prescribed drugs.
The boy is one of the cancer patients referred to the Hospice as their illness has reached the stage at which there is no longer hope for cure and that death may be close.
Cancer
The boy's parents have come to accept that soon their boy will be taken away by cancer, never to see him until they meet again in heaven. They have been counselled to accept the inevitable.
The boy is the youngest cancer patient to be attended to at the Hospice which is also known as the Nairobi Terminal Care Centre. The oldest patient is in his 80's.
And since the Nairobi Terminal Care Centre opened its door in March 1990, 85 cancer patients who have reached a stage at which there is no hope for cure have been attended to. Of that number only 22 are still alive.
Unlike hospitals which concentrate on curative measures, the Nairobi Terminal Care Centre gives "palliative" or "terminal" care meant to relieve pain and the distressing symptoms of the disease.
Dr Anne Merriman, the Health Services Co-ordinator, who is a full-time doctor at the Hospice, says the institution has simple inexpensive methods to ease pain and to allow the incurably ill <+_to> die with dignity.
The Hospice approach involves counselling of both the patient and his immediate relatives about the inevitable that is soon to happen to the patient so that all parties involved may be psychologically prepared.
Sometimes cancer patients are referred to the Hospice two or three days before death occurs. By this time the patient has suffered immensely from excessive pain.
Pain, according to Dr Merriman is the most expected and the most feared symptom for cancer patients. It occurs in one-third of patients receiving anti-cancer therapy, but in more than two thirds of patients with advanced disease.
This physical pain can be made worse by emotional suffering, social problems, depressions and anxiety. If advanced cancer cannot be treated, the pain can be treated, she said.
The treatment of the pain may be started with non-opioid analgesics such as aspirin or paracetamol, then progresses to the use of mild opioids such as codeine and, if pain persists, strong opioids such as morphine until the patient is free of pain.
W2B025K
Nutrition: How to control and treat obesity
After looking at the kinds, causes and risks of obesity, our net major concern is how to control and treat obesity.
The current methods include, 
* diet,
* exercise,
* psychotherapy,
* behaviour modification, 
* <-/phamacology> or drugs, 
* surgery.
Pertaining to weight reduction most people are interested in easy and quick methods. Hence the consumer has become easy prey for those providing magical ways of losing weight which promise something for nothing.
As we discuss the methods, keep in mind that there are some poor and some good choices.
The producers and advocates of water pills hold that excess weight is due to water accumulation. Indeed temporary water retention, seen in many women around the time of the menstrual period may make a difference of a number of kilos on the scale. Oral contraceptives may also promote actual fat gain in some people.
If water retention is a problem, it can be <-/diagonised> by a medical doctor who may prescribe a "water pill" (diuretic) and probably some restriction of salt (sodium) in your diet. However, the over fat has a smaller percentage of water than a normal person in weight. Hence if the obese takes a self prescribed diuretic she/he has done nothing to alleviate her fat problem despite the fact that she may <-/loose> some weight on the scale for half a day and may suffer from dehydration.
Some dieters take pills e.g. amphetamines to assist with weight loss.
These drugs have been shown to depress the appetite, but only temporarily. The appetite returns to normal after a week or so and the lost weight might be regained.
These drugs also cause dangerous dependency or "addiction". They may cause insomnia or loss of sleep, excitability and dry mouth. With this we can conclude that they (amphetamines) are of little use in weight control if at all they have any.
Also fenfluamine or phentermine has its own <-/soide> effects.
In some cases where there is no hypothroidism, thyroid <-_hormone><+_hormones> have been used. This hormone is expensive and not easily available and may cause loss of lean mass instead of fat.
Many other drugs have been used with the manufacturers claiming that they inhibit food absorption or synthesis in the body. Side effects are severe and many have been reported to be a health hazard.
One more known appetite depressant is cigarette smoking but we need not <-/delobour> its obvious hazards.
The health spa benefits from people's desire to <-/loose> weight and keep fit. These facilities can be used to your advantage. If you really exercise you reap the benefits.
But spas can be really  expensive and the unsuspecting consumer may fall for gimmicks that offer no real health advantages than the psychological boost.
Hot baths do not speed up your calorie expenditure at rest (basal metal bolic rate). Steam and sauna baths do not melt the fat off. What the two have in common is that they cause you to sweat and dehydrate, thus making dramatic weight reduction on the <-/scale>.
Machines that promise to jiggle your fat off while you lean passively on the machine provide only pleasant stimulation, no exercise and no fat reduction.
There is a fallacy about two kinds of fat. Regular fat and cellulite. Cellulite is said to be a hard lumpy fat that only disintegrates on burning up, it is said that only such methods as massage or hot spa can decompose them. It is true that sometimes fat will appear lumpy due to connective tissue attaching the skin to the underlying structure. However the above claim is nothing but a hoax.
Two major surgical operations undertaken in reference to weight control are.
Stomach stapling (or gastric <-/hypass> or gastroplasty) <-/by passes> a certain portion of the stomach. It is achieved by the "stapling" of the stomach to make it smaller. This forces the person to eat less food. Though pleasingly simple sounding, there have been reports of staples pulling loose. One should always think long and hard before submitting to it, for it damages stomach tissue and also forms scars.
Jejunoileal bypass involves disconnecting a portion (=90%) of the small intestines. The aim is to reduce the absorption of foods despite over eating. Side effects include massive and frequent <-/diarrhea> urinary stones, intestinal infection and sometimes malnutrition.
Hence surgical treatment of obesity should only be taken by the <-/morbidly> obese under the recommendation of a medical doctor. 
Nutrition: Is sugar good or bad for you?
Is sugar harmful or harmless? Should we use or avoid it? <-/Lets> consider arguments brought forward by those who claim that we should eliminate sugar and sugary foods from our diets. Then we shall give evidence of the dangers posed by - sugar in our diets and leave you to decide whether to use it or not and if you must, how much.
Those against sugar say:-
* It is not a nutrient but an additive which we do not need. It is not natural and may be dangerous. It may cause malnutrition (poor nourishment of the body by displacing some important nutrients).
* If it is eaten excessively calories from it may become excessive causing obesity.
* Too much of it causes some body organs (pancreas) to overwork trying to "digest' it. The end result is wearing out of pancreas causing diabetes.
* Excess sugar is converted into fat which can cause abnormally high levels of fat in the blood (hyperlipidemia). This increases the risks of developing heart and blood vessel diseases.
It is true that refined sugar (sucrose or table sugar) is new in our diet. The body has no need for it. However, it has a need for carbohydrates and sugar is a carbohydrate.
Carbohydrate has an important role to play in our diet. If the only carbohydrate available or acceptable is sugar, then it may perform a much more needed function. An example is that of a child with a kidney <-/diseas>.
The child needs protein to grow, yet the kidney can only handle a limited amount. Feeding a child like this is a difficult task for they often lack appetite. Feeding them sugar permits them to use the protein consumed for the energy they highly need. This also reduces the workload for the kidney.
Other starchy foods like <ea/>ugali and rice, could be used but they are not only more bulky than sugar but also less acceptable. For example, one slice of bread is approximately equal to 70 calories whereas two teaspoons of sugar yield 90. In this case, sugar is a valuable source of energy.
Upon digestion, sugar produces 50-50 mixture of glucose and fructose which finally becomes equivalent to pure glucose. This means that sugar does not differ from other starchy foods.
But unlike other starchy foods, it contains no protein, vitamin minerals or fibre. It can thus be termed an empty calorie food since it has no other value to the body. For example, if you have 500 calories to spend and you spend them in sugar, you get nothing for your outlay.
Then whether you can use sugar or not should depend on how many calories you have to spend. With careful selection of nutritious foods, the body needs could be met with less calories and the rest could be used on sugary foods.
If you use your calories on sugar and not meet your other needs, we can say that sugar has caused you malnutrition. This kind of malnutrition is not by any positive action of sugar but by displacement of nutrients. The appropriate attitude to take is not that sugar is bad but that nutritious foods come first. 
Whether sugar causes obesity or not is another major concern among nutrition-conscious people. Excess calories may it be protein or sugar are stored as body fat. It is true that obesity is linked to high sugar consumption. However, sugar cannot be blamed as the sole cause. Obesity does occur without sugar consumption.
Does sugar cause diabetes? Before answering this question it is important to understand that diabetes is not one but several disorders. There is the non-insulin dependent diabetes, which develops in those who are genetically prone. There is also the insulin dependent diabetes and another kind caused by chromium (a <-/dietrarymineral>) deficiency.
There is a strong correlation between obesity and diabetes. There is also a high correlation between high sugar consumption and obesity. However, sugar has neither been proven to cause diabetes. Now has it been proven innocent. Therefore both weight control and avoidance of sugar are recommended for those with diabetes as well as those who have the genetic tendency.
High sugar diets are linked to obesity. It has also been shown to increase the blood fat levels of the prone group of people known as " carbohydrate-sensitive".
However, sugar in limited amounts has not been shown to have influence on heart disease.
Tooth decay is becoming common in this country and even more common among those under 10 years of age. Sugar is one of the contributing factors. Tooth decay is caused by the acid by product of bacteria growth in the mouth.
Bacteria thrives on food particles especially if they contain carbohydrate. It is therefore logical to implicate sugar although any carbohydrate, including starch can support bacteria growth.
Some people may ingest sugar and sugary foods, yet never develop tooth decay for they have inherited resistance.
There is no reason to believe that moderate sugar consumption is dangerous to the normal healthy human being. As discussed above, sugar may clearly be associated with factors that are harmful - obesity, displacement of needed nutrients and fibres and dental decay.
If on these grounds you decide that sugar is to be avoided, it is important for you to realise that other sweeteners such as honey and raw (brown sugar) or <*/>jaggery are no better.
They may contain some minerals, but it would be absurd to rely on them for this purpose. You should also understand that sugar is hidden in many supposedly healthy foods. Be careful shopping or selecting these products.
A very good example is those who select bread or packaged breakfast cereals on the basis of their "<-/browness>" - the un-refined foods.
They fail to notice that despite their being whole, these products have added sugar. Sometimes, the sugar is excessive and makes them unable to <-/>to serve the purpose for which they are intended.
Many of us have at one time or another attempted to give up sugar but it is not easy. That raises the question as to whether sugar is addictive. We have a complex and intense relationship with food. Many factors are involved from the physiological need to emotional involvement - and the <-/consciousneess> of the <-_foods><food's> social meaning.
We develop a love for sweets from the very first time we taste them. For a baby, the immediate reward of sweetness is followed by immediate satisfaction of hunger. This attractiveness is great and <-_possess><+_possesses> some characteristics of addictive drugs. If you start eating a sweet food when you are hungry, you are likely to over eat it until you are too full for a nutritious meal.
We can cope with sugar and sugary foods by giving it a lower status in our diet. We should not look at it as an "evil" substance but a harmless unnecessary substance with only a small room in our daily diet. In teaching children about sugars, let your task not be the one of teaching them not to <-/east> foods but how to choose wisely. Learn to eat less sugar by:
* Substituting fruit juices for soft drinks. Remember that most juices sold around are excessively high in sugar.
* Reducing sweets, cakes, pastries and biscuits.
* Noting that many cereals and breads have added sugar. Read labels.
* Reducing sugar in your drinks like tea, mix soda water with the regular soda for less sugar.
Whether we should use other artificial sweeteners or substitutes will be discussed in a later column.
W2B026K
The heavy toll of pneumonia
Approximately four million young children around the world are killed by pneumonia each year, the 1991 " State of the world's children" report says.
The report, prepared by the United Nations Children's Fund (Unicef), says well-informed parents are the first line of defence.
It says that a quarter of pneumonia deaths could be prevented by immunisation against measles and whooping cough. Several hundred thousand deaths could be prevented by exclusive breastfeeding for the first two to six months of life, says the report.
When pneumonia occurs, early diagnosis and appropriate antibiotics could prevent most deaths, it says.
The report adds that parents should know that a child with a cough, or cold, who is having difficulty in breathing, or is breathing more rapidly than is normal, needs quick trained health care. And, thereafter, says the report, success depends on the availability of health workers, including community health workers, who can apply simple tests to distinguish pneumonia and <-/>and, if necessary, administer antibiotic tablets along with clear instructions on how to use them.
It says the goal of a one-third reduction in pneumonia deaths by the year 2000 could be reached by informing parents and by training community health workers, backed up by referral and supervision systems and by regular supply of essential drugs.
According to the report, diarrhoeal diseases kill approximately four million young children each year. Two-and-a-half million of these deaths are a result of dehydration.
The report says that success again depends on the well-informed parent. Diarrhoeal diseases can be prevented by breastfeeding, immunisation against measles, use of latrines, keeping food and water clean and washing hands before touching food.
It is stressed that when a child has diarrhoea, it is essential to keep feeding and to give plenty of the right kinds of liquid, including breast milk, diluted <-_gruels><+_gruel>, soup, rice water, or a special oral rehydration solution (ORS). If the diarrhoea persists for more than a few days, or is more serious than usual, trained help is needed.
According to the report, diarrhoeal diseases are <-_is> also a major cause, possibly the major cause, of child malnutrition. It takes away appetite and reduces food intake, it reduces food absorption and drains away nutrients; it consumes calories in fever and tissue repair.
When disease occurs up to 10 times a year - this is not uncommon among children in developing countries - then malnutrition is usually the result, the report says.
It is essential for parents to know that continued feeding of a sick child and an extra meal a day in the week or so after the illness is, essential to protect normal growth, says the report.
The report says that every year in the developing countries, parents spend over US$1 billion on mostly ineffective medicines for diarrhoeal diseases and respiratory infections - the two commonest childhood diseases which are > cause approximately half of all child deaths.
The report states that with less money, but more information and training, diseases can be controlled, adding that "unchecked, they will kill another 80 million children in the 1990s.
In the same report, Unicef has called for a world-wide effort to end mass child deaths and child malnutrition by the end of the 20th Century.
With 250,000 children still dying every week from common illnesses and one child in three in the world still stunted by malnutrition, Unicef admits that such a target will be more difficult to achieve.
But the impending success of the 10-year effort to immunise 80 per cent of the developing world's children by the end of 1990 has put new life into the idea of internationally agreed targets, says Unicef.
"That extraordinary achievement has not only saved 12 million young lives, it has also given the world new hope by showing what can be achieved when the international community commits itself to a great endeavour."
The first World Summit for Children, which brought together the largest ever gathering of Presidents and Prime Ministers in New York last September, adopted more than 20 specific new goals for the year 2000.
They include a one-third reduction in child deaths, halving of child malnutrition, primary school education for at least 80 per cent of the poor world's children, and several detailed aims such as ending the scandal of the 250,000 children who go blind each year for lack of vitamin A capsules costing less than two cents each.
It is in this ambitious list of commitments, drawn up after world-wide consultations and endorsed by over 150 governments, which Unicef is now calling on the world to rally behind. It says: "The declarations of political leaders are not enough," says the report. "The year 2000 goals must become the goals of society as a whole. They are the best framework the world has, in the decade ahead, for a worldwide mobilisation by governments, international agencies, educators, religious leaders, health professionals, voluntary organisations, the mass media, the business community, and members of the public in both industrialised and developing countries."
According to Unicef, the cost of achieving the year 2000 goals is estimated at around $20 billion a year - about as much as the world now spends on the military every 10 days.
"The time has come," says the report, "when aid should form part of a pact by which industrialised nations would make a commitment to increase resources and developing nations would make a commitment to real development."
It says aid should be linked to a developing country's commitment to improving the lives of the poor majority.
A 10-year effort to protect the lives and the normal growth of all the world's children, says the report, is a practical necessity as well as a humanitarian cause.
Unicef's executive director, Mr James Grant, says: "a great promise has been made to the children of the 1990s. Whether the promise will be kept is a question which will be answered not by the declarations of a day but by the deeds of a decade."
The first test will be whether political leaders honour the commitment, made at the Summit for Children, to begin working towards the year 2000 goals by completing a re- examination of national plans and national spending <-/priotities> "not later than the end of 1991." 
Why pregnant women eat soil
Some get so drawn to the habit that they eventually get addicted
Of all the delicacies, tuff is one that is least discussed. But its addicts crave for it as much as smokers crave for cigarettes and alcoholics for beer.
Tuff is a kind of clay that many pregnant women love to chew. Some get so drawn into the habit that they actually get addicted to it. They can smell it from a distance. This makes it easy for them to look for it.
Peterson Kamotho Gachago of the University of Nairobi says tuff is a geological name give to volcanic soil which is solidified.
Gachago is a postgraduate student of environmental chemistry. He has been researching on it since September last year.
In his research, Gachago found two types of tuff. One which is sold in Biashara Street, Nairobi, in packets. This is imported. The other is local and is sold in crude form at Gikomba market. One packet of about 124 grams costs Sh4. A similar amount of the local tuff coasts 50 cts. The imported one is called <ea/>mahti.
Gachago's findings show that <ea/>mahti has low levels of iron, manganese, zinc and zirconium when compared with the local one. The elements of calcium, potassium and rubidium were not detected in a <ea/>mahti sample.
On the other hand, there were some elements found in <ea/>mahti which were not found in the local soil. They were chromium, titanium and nickel.
The theory behind pregnant women craving for tuff is that they may be having iron deficiency in the blood. Since the woman is catering for her and the growing baby's needs, she needs a higher supply.
Since other animals reproduce, do they have a similar craving?
Gachago's observation is that when cows have sodium and calcium deficiency, they are seen developing strange appetite for such objects as bones and washing soap.
His research has been done on 28 female rats divided into two groups. Seventeen of them which were experimental were fed on the ordinary rat food (rabbit pellets) plus grounded tuff mixed with the food. The remaining eleven were fed only on rat food.
Among the things observed in the two groups was a difference in the weight gain. Rats receiving tuff gained weight from an average of 74 grammes to 129 grammes. This is an equivalent of 74 per cent gain.
This is much less compared to the weight gained by the control group of an average of 105 per cent. That is from 74 grammes to 151 grammes.
Another observation was that the control group had well-groomed fur and were very active. The tuff-fed animals appeared lethargic and their fur coats were rough.
Looking at the breakdown of the metals found in tuff. Gachago says there are some like titanium whose role in the body is not known. <Ea/>mahti has about five per cent titanium.
As far as health implications of eating tuff are concerned. Gachago says that chromium is useful in the clotting of blood. Above its useful limits, it can cause lung and liver cancer.
Iron at low level assists in the manufacturing of blood but high concentration leads to liver cirrhosis and lungs siderosis (fibrosis of the lungs).
Lead on the other hand has no useful effect, is toxic and can lead to mental retardation of the baby. The baby is also likely to have deformed teeth.
Gachago who says that the research is still continuing adds that he is not quite sure why some women get addicted to tuff even long after delivery.
Women who chew tuff say they just feel nice when they chew it, that they are not sure why they do it, that they feel a little thirsty until they eat some. Tuff lovers have a space in their handbags specifically reserved for it.
A women whose last child was born more than six years ago says she still cherishes the taste of tuff since her last pregnancy. She adds that the desire for it becomes intolerable when it rains.
Danger of toxicity aside, tuff eaters stand a chance of introducing parasites like worms into their system. Dr. Ndwiga Mwachandi of Canaan Medical Stores does not see this as the greatest threat since most of the women dig deeper into the soil. This means they get sterile soil that is devoid of worms.
But he says that eating soil at random could introduce worms and bacteria into the body.
The soil especially in agricultural areas could be contaminated with dangerous chemicals. Excess of a mineral such as silica is associated with a certain type of elephantiasis, he says.
Heavy metals like lead and mercury mixed with the soil can lead to diseases, he adds.
The doctor says he does not know exactly what causes the craving for the soil but recounts an experience that puzzled him.
It was a case of a woman who had fibroids (muscular swellings on the walls of the uterus). She had an extreme craving for the soil. It was recommended that the uterus be removed. Once it was removed, the urge immediately ended.
"In her case, I do not know whether it was a message from the uterus to the brain behaving as if it had a baby," he says.
He suggests that there might be lack of iron in the body's "granary" due to a woman not having been taking a balanced diet. He however expresses surprise that children suffering from marasmus and kwashiokor do not crave for the soil due to a similar deficiency. 
W2B027K
Parasitic diseases defy vaccines
The eradication of many diseases such as smallpox and to some extent measles and polio can be emphatically attributed to vaccination programmes.
However, the success recorded in developing vaccines against infections caused by viruses has not been found in development of vaccines against parasitic infections caused by protozoa such as malaria, and by worms such as schistosomiasis (bilharzia) and leishmaniasis. The main reason behind this is said to be the relative complexity of parasites compared to viruses.
The complexity of parasitic organisms has contributed not only to some difficulties in diagnosis of infections, but has also imposed constraints upon designing of vaccination strategies. A major aspect of this complexity is the ability to evade or modify the immune response of the host.
To date, there are over 200 parasitic worms known to infect man. This perhaps is one reason why it is difficult to make an unequivocal identification in infected individuals and the number and type of parasites present.
Of the over 200, the most popular with researchers so far has been the schistosome and filariasis-causing worms. Their method of transmission have  justified the need for intervention through vaccines. Well-focused attention on control of parasitic infections has however been jeopardized by low morality and high morbidity associated with the diseases, such as filariasis and schistosomiasis.
Despite the low mortality these infections still provoke severe disability through lesions and malnutrition, or blindness in the case of filarial infections.
With the advent of AIDS, the consequences of chronic parasitic infection can be expected to worsen, due to the suppressed immune system associated with AIDS.
Most research efforts towards development of a vaccine against parasitic infections in the last decade has been directed towards developing a vaccine against malaria, especially the parasite Plasmodium falciparum. These efforts have been given more impetus in the wake of revelations that P. falciparum can be resistant against chemotherapy, especially with chloroquine. The first occurrence of Chloroquine-resistant Plasmodium falciparum (CRPF) in Kenyans was recorded in 1982.
At the moment, malaria exacts a huge toll in mortality and morbidity in Africa and is the leading killer disease in children, claiming a million children each year.
The disease occurs after a person is bitten by the anopheles mosquito vector which carries mature sporozoites in its salivery glands. The sporozoites enter the victim's liver and later red blood cells. This infection of the red blood cells is what presents itself clinically as malaria.
Research efforts aim at developing a vaccine that could block the invasion of the liver, blood cells, inhibit the development of the disease and prevent transmission.
Ideally then, the vaccine would consist of at least three antigens, to act against the three stages.
Schistosomiasis is thought to rank second to malaria among major parasitic diseases in terms of morbidity and mortality. Despite the development of an effective drug (Praziquantel) this status has not officially lowered. The situation in Africa is not likely to change, especially given the continued expansion of irrigated agricultural projects such as the Mwea Project in Embu.
Researchers at the Kenya Medical <-/Reserch> Institute (KEMRI) are at the moment doing a socially oriented study that aims at encouraging the community to prevent infection (Primary Health care). Scientists have estimated that currently more than 2 million Kenyans have been infected with bilharzia.
One problem with treating schistosomiasis with drugs is the prevalence of re-infection especially in young children, necessitating repeated treatment and sometimes indefinite surveillance.
Another common parasitic infection is leishmaniasis. In Kenya, this disease is prevalent in parts of Machakos, Kitui, Meru, Bungoma, Baringo, West Pokot, Laikipia and Turkana districts. The disease appears in two forms: cutaneous leishmaniasis and visceral leishmaniasis. The former presents as solitary and multiple disfiguring lesions on exposed parts of the body, while the latter attacks the liver, bone-marrow and spleen, resulting in a distended abdomen in the victim.
The current method of diagnosis of visceral leishmaniasis in Kenya which is a painful and risky technique involving removal of fluids from the spleen, through suction. Visceral leishmaniasis can be fatal if not treated early.
The disease is spread by a nocturnally active insect known as the sandfly. The treatment currently in use is unsuitable for most Third World countries since the drugs are expensive and require administration over a long period of time. Moreover, the victim still suffers from the everlasting scars in the case of cutaneous leishmaniasis.
One method of intervention that has been tried has been "leishmanization". This is deliberate infection with leishmania to induce long-lasting immunity against cutaneous leishmaniasis. This method has been tried in USSR and Israel. In Iran, where other control methods failed, the high incidence of the disease along the Iran-Iraq war zone led authorities to give live inoculum to recruits and volunteers before sending them to endemic areas.
Side by side with the search for vaccines has been the development of anti-parasitic drugs. With parasitic vaccines still being elusive, manufacturing companies have continued to bring in new and better anti-parasitic drugs into the market.
The vaccine however still would be more ideal, principally because it would be prophylactic in its effects, that is, it would prevent development of disease. Few anti-parasitic drugs have significant chemoprophylactic activity and on the token that prevention is better than cure, vaccines would be <-/preferrable>.
Another advantage of the vaccine would be that while drugs require frequent dosing schedules (daily or weekly), a vaccine would provide protection for months, years or even for life. This means that a vaccine would be less expensive and more appropriate logistically.
The other problem is that some infections develop resistance to drugs, such as has been the case with chloroquine resistant Plasmodium falciparum.
Drugs, too, have their advantages over vaccines in that at times they can be used to prevent as well as cure diseases. Secondly with drugs, no intervention is necessary in healthy people. Also, vaccines tend to require refrigeration, unlike most drugs.
It is important to note, however, that the presence of vaccines would not mean that the infections will disappear. Many good vaccines are still not universally employed, even when they are relatively cheap. Vaccines against poliomyelitis and measles, for instance, are still not fully utilised.
For developing countries, probably the most urgent control methods should be non-invasive, such as improvement in housing, sewage disposal and water supply.
This is the approach that is being followed by KEMRI field researchers at Mwea and Kwale. The emphasis is on community education, construction of latrines and bath units in the rice paddies and villages, construction of wells and of course treatment of infected people. 
Fighting malaria menace
Malaria control is the reduction of Malaria to a level at which the disease ceases to be a major public health problem. It can be achieved through the rational use of various antimalaria measures adopted to local epidemiological conditions. James Onyango looks at the problems encountered in a malaria control programme.
The malaria parasites are haematoza - that is, they live in human blood - and it is the small anopheles mosquito which transmits the parasites by biting, at random, first a malaria patient then a healthy person.
Malaria can strike and kill anyone, but experience shows that it affects primarily the poorest groups of populations. These social groups of people have the least access to hospital services, can least afford personal protection and are the furthest removed from organised malaria control activities, and it is important to note that it is they who support the estimated one to two million deaths per year attributed to malaria.
Whenever malaria is present, it interferes with human progress and development, only by bringing it under control can its disrupting effects be overcome. Malaria problems arise when development projects such as dams and irrigational schemes and, more important, when communities and the individuals try to bring about economic improvement in disorganised ways which increase contact between man and mosquito.
A global programme for the control of malaria was initiated by WHO in the 50s. Today, more than 30 years later, it has been realised that eradication is not feasible more so under the current economic conditions. Hence <-_is><+_in> order to control malaria the best approach is to fight it on many fronts. These <-_includes><+_include>:
* Vector control
* The use of anti-malarial drugs.
* Appropriate diagnosis.
* Community participation.
Vector control simply means reducing the mosquito menace. <-_It><+_If> we could prevent all contact between man and the anopheles mosquito which transmits malaria, this disease would not exist. Malaria has been eliminated from numerous countries in the temperate zones and in the subtropic where the disease was relatively unstable and not very deeply entrenched. Vector control measures, case treatment, and surveillance were very well within the means of the countries concerned and were applied with a high degree of precision.
In some countries, financial, administrative, political, and operational difficulties have impeded the proper running of anti-malaria programmes, although the available technical methodology would have permitted the complete interruption of malaria transmission. In tropical Africa, none of the available, financial and logistically feasible technologies is adequate to produce a complete interruption of malaria transmission or even a major reduction of malaria prevalence, since environment, sector, and parasite show a high degree of harmony not seen elsewhere.
In addition to the basic obstacles, there are other problems. Most important is the resistance of anopheles mosquito, especially to chlorinated hydrocarbon insecticides such as DDT introduced in the 50's.
Removal of the breeding places of mosquitoes is the most effective method malaria control where mosquito breeding is confined to water collections <-/amecable> to this type of measures, e.g. swamps, marshes rain pools, the backwaters of rivers, seepage pools, and borrow pits. However, these breeding places abatement  may not be acceptable to a government or a population for environmental or economic reasons, as has been the situation in tropical Africa.
Man-vector contact can be blocked by the screening of doors, windows and other openings of human habitation by the use of insecticide impregnated curtains and also by the use of mosquito nets impregnated with insecticide, provided that man stays confined to the screened environment for the whole duration of the vector's biting activity, that is, usually from sundown to sunrise. The major constraint here is the affordability of these materials.
The use of drugs may reduce or even interrupt malaria transmission. However, drug resistance which has been noticed for quite a number of anti-malaria drugs becomes an important factor affecting malaria control at the present time. Mass drug prophylaxis (preventive medication) of malaria, as a control measure, is very difficult and expensive to apply.
It requires a highly organised system of regular drug distribution in order to achieve the essential coverage in space and time; the less concentrated and the more mobile the population, the less effective and the more difficult drug prophylaxis will be. However, drug prophylaxis is useful for the protection of well-organised and continuously or regularly accessible groups under special risks, e.g. international travellers.
In order to institute drug treatment in the case of malaria, the provision of early diagnosis should be the essential part of malaria control. Whatever the social and economic circumstances, this should be considered a basic right of all populations at risk. It is therefore vital to <-/intergrate> it into primary health care <-/activites> at the district level. It has been argued that wherever the transmission risks are high every member of the public can learn to recognise signs of the disease and institute prompt self medication.
This it has been noticed can be very risky. Reports in the Kenyan dailies of deaths in North Eastern Province and in the Baringo area due to other diseases other  than malaria is a case in point. The population, it has been reported have instituted antimalarial treatment without proper diagnosis. A combination of insufficient and improper diagnosis and the use of anti malarial drugs when not warranted has <-_lead><+_led> to deaths.
The microscopic examination of blood has been the mainstay of malaria parasite detection in infected mosquitoes and in man, but this method has serious shortcomings in that it is time consuming and often not practical at the peripheral levels of primary health care more so in epidemic situations. 
W2B028K
The Jungle
Screw-worm menace
The African wild-life is under threat of extinction, not from poachers but from a voracious flesh eating fly known as screw-worm fly, unless measures were taken to eliminate it from its new home Libya.
Screw-worm lays its eggs in open wounds of animals, whose flesh is later eaten by insect's maggots into gaping wounds.
According to Food and Agriculture Organisation experts, new born animals are in danger since screw-worms are fond of laying their eggs in the unhealed umbilical cords wounds. In this way over 90% of new born animals die.
The scientific name for this killer is Chochliomyia homini-vorax, which is the Latin for "devourer of men." Not only are the animals <-_are> at risk but children are in danger of this blue-green female fly that tends to lay her eggs in small scratches or body cavities like mouth, ear or nose.
The screw-worm origin is in American continent, where it is found within the sub-tropical and tropical regions. But about two years ago it found its way to Libya from Uruguay.
Since then it has spread to over 20,000 square kilometres on both sides of Tripoli. Over 3,000 animals and 300 people have been attacked by the insect since 1989.
Fear is that the insect might have found way inside Tunisia where it is expected to spread to other parts of Africa.
FAO experts think that spread of screw-worms in Africa could be disastrous to both animals and people.
Screw-worms are capable of laying several batches of eggs in just a few days. One of them can lay several batches of 400-eggs every three days. In Americas, screw-worm is controlled by natural predators.
Transplanted to Africa with no natural predators in sight, FAO officials think that this could be extremely dangerous, since everything is right for it. Although some countries could afford to treat domestic animals wildlife would be in real danger.
There is danger that the insect would spread to all areas with temperatures of above 20-degrees centigrade. It would be difficult to imagine the terror that would be introduced into the wilderness among the already, depleted numbers of elephants, buffaloes, rhinos, lions and a host of other animals.
Through the release of sterile male flies, the screw-worm was eradicated in United States. This was also facilitated by strict control of animal movements, quarantine, inspection of herds and treatment of infested wounds by insecticides. This kind of control is not possible in Africa especially if the wild game were infested with screw-worms.
The sterile male technique helps eradication because any female fly that mates with a sterile male lays eggs that will not hatch. The female usually mates once, while males are rather polygamous mating five to six times. This method is the one that will be used by FAO, UNDP and IFAD towards eradication of the fly in Libya.
The sterile male flies are being developed at Chiapas Radiation Plant in Mexico and would be released at the rate the of 100-million flies per week over a period of 20-week period says FAO officials. Estimates are that the scourge will be eliminated within two years before it spreads to the rest of the continent.
If this is not achieved, Africa must prepare for disaster, because there is no guarantee that the fly could be kept under control in Libya forever.
The fears are that apart surviving within tropical and sub-tropical climates, it could perhaps acclimatise itself and endure harsh cold weather. From here then it could find its way to southern Europe, Asia and Middle East.
Despite their political differences, agricultural experts from US are now in Libya working closely with FAO and Ifad experts in waging a campaign that has left political considerations to be forgotten for a time in a period of threatening screw-worms menace. 
Caring for patients with skin diseases
In our past two articles we explained broadly how home based care works and what is expected of family members providing care to their Aids patients at home. Today we continue to give useful tips on skin diseases that commonly affect Aids patients and what care providers must do to manage them properly.
We have chosen skin diseases for a number of reasons, one being that the skin in itself is universally very special to its wearer. The skin is a blanket for the entire body and largely defines our physical beauty and how we look. You may agree with me that a smooth, spotless and healthy skin brings much joy while a distorted and disease-ridden skin normally brings distress to people prone to skin problems such as leprosy were present long before Aids was discovered. Many people with Aids continue to suffer from skin diseases too, hence the need to help them understand how to deal with them.
A much more important reason is that the fear of Aids and of HIV infection is still with us. This fear is even worse in Aids patients with skin disease because people can easily see or notice their skin condition. The skin is the most visible part of the body. We must all try to remove this fear through education and letting care providers know that they cannot get HIV infection through casual contact with the Aids patients. Infected and open wounds with pus and blood are infectious and the care provider must be very careful not to touch the wound with bare hands especially if there is a cut in it. This is because the care provider may get infected unless certain precautionary measures are taken first.
The other reason is merely a question of numbers but nonetheless still very important to us. Skin diseases and related skin problems are more than common among Aids patients. This is because their immune systems are already too weak and cannot resist invading germs. Dr David Owili, chairman of National Aids Control Programme and skin specialist says that almost all Aids patients suffer from one or a combination of skin problems at one time or another during their condition.
This means that an equal number of relatives or more will have to provide skin care to their Aids patients at one time or other. Therefore, these care providers need to know at least how to identify skin diseases and how to deal with them properly.
Some common skin problems allocating Aids patients comprise of severe itching, rashes, scaling, flaking and excessive dryness of the skin. Dandruff is often worse when someone has Aids. Of course you need not worry about the common dandruff we all feel on our hair, the dandruff associated with Aids and scientifically referred to as seborrhoea dermatitis is a much more serious condition. The dandruff in this case later tends to appear all over the body. Some common skin problems may be caused by poor hygiene.
The skin excretes certain toxins and poisons which should be washed off from time to time. Other skin problems like redness and rashes may be caused by allergy to certain drugs. Aids patients are more prone to allergy to some anti-tuberculosis and anti-cancer drugs and some antibiotics.
(Aids Home Care Handbook, the Global Programme on Aids, World Health Organisation, 1993). Serious skin problems suffered by Aids patients include cold, sores, ulcers, wounds, boils and abscesses. These conditions may be caused by various germ infections such as virus (herpes zoster herpes simplex), bacteria (ferunclosis, impetigo, pyoderma), fungi (candigosis, dermatophtosis and <-/tumors> (kaposi's sarcoma).
Skin diseases in Aids patients can be very severe. You need to see it to believe just how serious these <-_disease><+_diseases> can be. The practice has been to isolate the patients in special wards, which is not necessary.
The resulting physical pain form these severe skin infections cannot be exaggerated. To make matters worse, these skin infections cannot be completely cured and continue to attack the patient from time to time. In such a case, the management of the infection should be palliative in approach, that is, aim to lessen the physical pain and suffering of the patient.
PROVIDING LOCAL DESION (SKIN) CARE AT HOME
According to the WHO/GPA guidelines on home care, people providing care to Aids patients with skin problems must, as a rule, clean the patient's skin regularly with soap and clean water and keep the skin dry. The patient's nails should be kept short and clean to prevent the scratching of itchy wounds and sores. Scratching may break and expose the skin to further germ infection. WHO advises patients to cool itchy skin using cold water and to smooth it with oil such as Vaseline.
The skin must not too dry because dryness encourages itching. Where the skin is very dry the patient should avoid using soap and other detergents. WHO recommends the use of ordinary vegetable oils like <ea/>kimbo or <ea/>kasuku and even common traditional remedies where available like coconut oil.
When dealing with a wound, it is very important for the care-provider or the patient to know whether the wound is infected <-_of><+_or>  not. A wound is infected if it becomes red, swollen, hot, painful and has smelly pus, says WHO. A care-provider can tell when the infection is spreading to other parts of the body if the patient has fever, if there <-_if><+_is> a red line above the wound or <-_it><+_if> the lymph nodes under the skin in the armpits or neck are swollen or tender.
WHO advises that an open and infected wound should be washed regularly with clean water mixed with a birch of salt. A wound with pus or dead tissue should be cleaned from the edges first then washed from the centre out to the edges. This permits the pus to ooze out and the dead tissues washed away evenly. While doing so, the care-provider is reminded to use gloves or plastic bags to avoid touching pus or blood. If the wound is dry, it should be exposed to a lot of air to heal as soon as possible. But when it still has pus or blood the wound should be covered with a clean piece of cloth or dressing after it has been cleaned. Dressings are very important because they prevent the wound from further infection and also protect other people as well as keeping the medicine applied on it in place.
The dressing should not be tied tightly so as to allow the free flow of blood into the cells around the wound. It should also be changed at least once a day. This gives the care-provider a chance to monitor any signs of <-_injection><+_infection>. While changing the dressings, care should be taken not to let soil or any dirt get into the wound because this may result into a tetanus infection. WHO advises that patients with wounds be immunised fully against tetanus even if they had been immunised in the past. Ideally, dressings should be burnt or put in a landfill or pit latrine after use. If they must be used again, they should be boiled in hot water and dried thoroughly. A disinfectant like Jik should be used where available.
Other things which help heal a wound are soaking in salt water or applying a hot compress four times a day. The same should be done to boils and abscesses to make them mature and drain away. If the boil fails to mature and instead becomes bigger and very painful, a doctor should be consulted.
For wounds caused by viral intentions such as <-/nerpes> zoster, WHO recommends the use of anti-biotic creams to stop further infection. The patients can also be given pain killers and at night sedatives to relieve severe pain associated with herpes zoster. According to the National Aids Control Programme, a variety of drugs whose use were previously restricted are now readily available to help in the treatment of skin diseases related to Aids.
Doctors, nurses, community health workers and interested people are requested to debt information on how to use these drugs from NACP in Nairobi. This information is also available in a document called Clinical <-/Creterin> and Management Guidelines for Adult and Paediatric Aids by the National Clinical Sub-Committee on Aids.
W2B029K
Science
Healthy forum for medical experts
The Kenya Medical Association should be complimented for organising the first conference involving different medical specialists.
The "First Joint Conference of Medical Associations and Societies in Kenya", which ended last Friday, was in itself a positive achievement. But it was the honest and spirited discussions aimed at making international healthcare more effective that made it a significant and historical event.
The theme, "national healthcare provision and development", plunged the experts into issues linked with the availability of basic human needs. The Minister for Health, Mr Mwai Kibaki, who set things in motion, said that the 11 per cent of the budget set for health services may not change.
This means that steps must be taken to provide effective health services at costs which can be afforded by poor Kenyans. But this cannot be attained with the escalating costs of curative medicine.
Participants were told that Kenya spends up to 70 per cent of its health budget on curative medicine and that very little is allocated to the prevention of diseases. The attainment of health for all by the year 2000 depends on prevention rather than curative medicine.
Mr Kibaki said that Kenyans were already on the wrong path because of associating hospitals and health facilities with good health. "In villages people ask for more hospitals instead of clearing the bush and draining water to get rid of malaria, the Minister added.
Mr Kibaki reminded doctors that there was an urgent need to boost preventive health services or primary healthcare via community participation. This would reduce the country's dependency on imported drugs and medical equipment.
The honesty and seriousness of the discussions was reflected in the issues participants analysed. The Director of Medical Services talked of many national health issues which must be examined by medical professionals to help the country attain its health objectives.
"In fact I envy the mental health section because it has attained recognition while dental health is still sidelined," Dr Ndung'u added.
There was an interesting presentation on fluorides whose occurrence in water and toothpaste has in the past generated controversies.
There was also a presentation by the Chief Pharmacist, Dr Elizabeth Ogaja. She has been a leading activist against the sale of non-essential and ineffective drugs.
In Kenya, there have been cases of companies accused of, for example, selling simple dyes and sugar in the name of vitamins. Others have been known to repackage expired drugs from elsewhere for sale.
Indeed it must be said that up to now, what most local pharmacists do is formulate and repackage drugs. There are hardly any industries that begin their operations from zero.
However, the most interesting and controversial presentation was from Dr. J. Aluoch, who, as the chairman of KMA, shocked his audience with his bold statement that, "medicine was never intended to be peddled like commercial merchandise and private practice actually works against the national healthcare system".
Dr. Aluoch is a rare man and the fact that he is in a thriving private business means he knows what he is talking about.
Kenya has more than 3,000 doctors. This means about one doctor per 7,000 people while the World Health Organisation sets a minimum target of one doctor per 10,000.
However, this is misleading because up to two thirds of these doctors are concentrated in cities and are in private practice. Actually, many ministry experts say that the real ratio is one doctor per 50,000 Kenyans and that it is even worse in rural areas.
According to Dr. Aluoch, private practice defeats the noble aim of health for all by the year 2000 because it thrives on curative medicine. And even if these doctors joined the preventive effort of medicine they would charge a fee for participating in the boosting of health services. 
Health's new challenges in focus at experts' talks
Although what Kenya and other African nations need in the war against diseases threatening millions of lives is more action and less talk, Nairobi will host yet another health conference discussing some of the latest techniques and drugs used to control and treat disease.
There have been at least five major health seminars within the past three weeks and for most doctors, these serve as major forums for continuing their medical education. One of the most important and interesting seminars discussed some of the latest trends in management of chest infections.
The germs causing serious chest infections - especially pneumonia and tuberculosis - are posing major problems and are defying effective treatment because of resistance to drugs which has come up partly because of Aids.
There is a global increase in cases of upper-respiratory infections and medical researchers say that effective treatment no longer depends on mere administration of antibiotics considered effective against the <-/targetted> germs.
But the problem is complex. During the recent launching of the antibiotic Ceclor - which has been used in the country for four years - a British medical expert, Prof Peter Cole, said doctors can no longer afford to ignore some bacteria considered quiet and rather harmless.
Prof Cole told the 420 doctors gathered at the Inter-Continental Hotel for a lecture on the latest trends in the management of respiratory tract infections, that laboratories tend to ignore or fail to identify the presence of a potentially lethal bacteria called H. influenza.
This bacteria could be a silent killer because it sabotages and undermines effective treatment of upper respiratory infections.
The situation is even more lethal for smokers because, according to the British expert, its growth is boosted by the addictive compound, nicotine, found in cigarettes. He said the antibiotic, Ceclor was among the most effective drugs in treating respiratory tract infections.
Prof Cole said patients could be dying because medical experts still did not consider or underrated the bacteria by failing to consider it as a leading cause of lung infections.
The doctors were told that this bacteria produces substances that make lung cells ineffective in producing mucus which helps defend the body by trapping germs.
Other speakers at the session included Dr M.S. Abdalla and Dr J. Aluoch.
Another important meeting was the 1994 Guinea Worm Eradication Programme Review Meeting. Although guinea worm affects only a few people in the world, the idea of eliminating the disease is a huge task with major implications for the biomedical world and the human race.
It is the concept and procedures used in the eradication exercise that is given close attention, because of their potential use, in any future attempts to eradicate disease.
History was made when the world managed to eradicate small-pox. There are now strong moves to destroy the last stock of this lethal virus kept by both the US and Russia. For centuries, small-pox killed million of people.
The call to destroy <-/small pox> stacks kept in Moscow and Atlanta is being justified by the fact that genetic engineering can be used to keep a "harmless" form of the ancient killer virus.
Thus, it is said that the world - which is being overwhelmed by new infections and germs that are resistant to treatment badly needs another successful disease eradication programme.
Signal
Thus, the World Health Assembly's target of eradicating guinea worm disease by the end of 1995, could signal that mankind can still win the war against diseases.
At least 120 million people in 17 African nations are at risk of being infected by guinea worm, Dranculus medinensis. In Kenya, the disease is mostly found in northern Turkana while active search for the disease is going on in five districts including Kitui, Trans Nzoia, Samburu and West Pokot.
The meeting was also attended by top medical experts from the World Health Organisation, Global 2000 and Unicef. The discussions were based on the work going in Nigeria, Ghana, Sudan, Uganda, Kenya and Ethiopia.
The head of Unicef regional office for Eastern and Southern Africa, Mr Cole Dodge, said development workers in the wartorn Horn of Africa could find it easy to pursue their goals if peace is attained.
He said Africa faced other challenges including the eradication of iodine deficiency, measles, polio and other preventable diseases.
Dr Joseph Christmas, head of Unicef country office who also helped the UN agency's guinea worm programme, said the disease is taken for granted and is even ignored by policy-makers and planners.
However, he said, its socio-economic implications are unlimited and Nigeria woke up when research showed that the country was losing $20 million (Sh1.1 billion) annually, due to its debilitating effects.
"Education and agriculture are usually the hardest hit. In Nigeria, children failed to attend school for three months while farmers, grounded by pain, could not attend to their crops," Dr Christmas added.
It is easy to reduce cases of guinea worm disease but it requires patience and determination to eradicate.
"Although guinea worm disease remains a minor health problem confined to a small part of the country, wiping out a disease is a difficult and rare historic task," he added.
Experts will know and follow up individuals considered as the last or final cases of disease to eradicate guinea worm, he said.
Dr Donald Hopkins from Global 2000 said the biggest problem in the eradication programme is people's thinking and there are those who say the task should not have even been started because the problem is too big and the time too short.
"Even two years before small pox was eliminated, there were experts who doubted the pending success," Dr Hopkins added.
He said eradication involves filtering water, provision of piped or safe drinking water, addition of chemicals like abate and community health education.
Kenya's guinea worm eradication programme is headed by Dr D. Sang who said intensive work is going on in the five districts.
Another conference at the Aga Khan Hospital had special sessions on burns, Aids and drug resistance which attracted much attention. There were days when plastic surgeons were seen as a bunch confined to the cosmetic side of medicine.
They specialised in changing and modelling body parts - noses, breasts, <-_cheek><+_cheeks>, hips and lips - of actors, beauties and celebrities. However, their role in handling of burns and other deformities is now crucial to the survival of thousands of people in Kenya. Much of healing of burns involves planting of new skin - grafts. Human skin can be grown in special labs or it can even be stretched sixfold to cover large surface areas and those who attended the session discussed some of the latest techniques involved in skin grafts.
The story of drug resistance is chilling and even involves amputation of infected limbs. The medics were told to return to simple but effective substances like iodine and chlorine.
Kenya is also one of the developing nations planning to set up a national cancer control programme and has received some support from the World Health Organisation's Global Programme for Cancer Control, WHO representative, Dr Paul Chuke, told cancer experts meeting in Nairobi.
Already, a group of 10 experts are helping establish cancer control programmes and the WHO has agreed to the committee's request for money, to enable them produce the first draft of the programme. Cancer is forcing itself onto every country's health agenda," he added.
Dr Chuke was speaking during the opening of the conference by the Pan-African Psycho-Oncology Society. He said that there has been tendency to ignore mental health but Kenya is one of the few nations which includes it in its primary health care programme. The participants included cancer experts from South Africa.
Epileptics are still mistreated despite increasing knowledge about the disease. A new anti-epilepsy drug, Lamictal will be launched by Wellcome after completion of a five-day training workshop on Friday this week.
The training session will deal with factors causing epilepsy which affects at least one person per 100 in some areas and could <-/>could severe brain damage if patients fall and injure their heads. The training session will include discussions on brain functions and structure and diagnosis of epilepsy.
The drug has been tried on over 4,500 patients and is alleged to be effective for treating "resistant epilepsy." 
W2B030K
Aphid problem not yet over
A general lull seems to be hanging over cypress aphids, the much publicised environmental problem that sparked off anxiety countrywide recently.
It appears the pest outbreak no longer exists and all the hue and cry made was only alarmist.
Since the second half of last year, the cypress <-/aphidsoutbreak> sparked anxiety and fear because of the extensive potential it indicated in destroying all the green cover in this country.
Well nurtured and trimmed hedges turned brown and age-old forests gave in to a monster that took the very guardians of the treasured green cover by storm.
Within months of identification, the monster was spreading like bonfire - from Narok, Kiambu Nairobi, Murang'a, Nyeri, Meru, Nyandarua, everywhere. It had first been sighted at Kiserian in Ngong.
The anxiety expressed was as alarming as it was scaring. Perhaps closer Aids.
Farmers and foresters went scrounging for emergency solutions. They found it in the form of chemical sprays which gave some consolation. But not a lasting one.
Well, that anxiety has since subsided, at least for the majority of the Kenyan public who have little understanding of this monster. There has been less talk about it probably because some of the hedges and plantations have slowly begun to turn green.
The farmers are no doubt heaving a sigh of relief thinking the problem is solved.
But the monster has only been down, not out.
Cypress aphid, a yellowish-brown insect with a body size similar to a body louse, is still around.
But the little green cover that has picked up is only an evidence that it has subsided. Scientists who have been monitoring its trends within and out are attributing the low infestation to weather trends.
"The cold and rainy weather has left many of the aphids dead and the reproduction capability lower, says Jackson Maina, a senior forest officer in the department of forestry in Nairobi.
Showers, he says, have a tendency to wash them down to the ground.
But the cold and rainy weather lasts only <-/upto> July and it is expected that the aphids outbreak will pick up as soon as the weather becomes warmer again.
"What we have had in the last few months is only a break in the past months but the potential problem is still as bad," Maina says.
"We already have reports of fresh infestation in warmer areas that had none at all."
That includes Taita Taveta district and a reinfestation in some parts of Baringo which have started to warm up.
"If you see trees recovering, it means that the reproduction process of aphids has slowed down. But not necessarily wiped out," says Maina.
A recent report by the Kenya Forestry Research Institute's (KEFRI) director, Dr Jeff Odera and E.K. Mutitu, states that peak population occurs between October and December. They also observe that misty areas like Kinale, Kitale, Molo, Londiani and others, have a lower aphid population.
"There is strong evidence that heavy rains and the hot dry season influence the development of aphid population resulting in an oscillating pattern," the report states.
This weather-related pattern has also been observed in Malawi where the first occurrence of the aphid in Africa was reported between 1986 and 1987.
The aphid has <-/todate> infested between 1500 and 2000 hectares of cypress forests in that country and spread also to Burundi, Rwanda and Tanzania.
In Kenya, the outbreak spread to a substantial part of the country and damaged 200,000 hectares of cypress species, in exotic and indigenous forests, plantations, hedges and woodlots.
The remaining 310,000 hectares of green cover - 200,000 indigenous trees, 80,000 exotic plantation and 30,000 of hedges and woodlot remain threatened.
"This is a big loss," Maina says.
In order to arrest the problem, the department of Forestry in collaboration with Kefri and ICIPE, has established a project called Sustainable Integrated Management of the Cypress Aphid Project for Kenya, which is intended to undertake short and long term control measures to contain the problem.
The project is however at its early stages and is awaiting funds to enable it operate efficiently.
"We require 8.6 million US dollars for the five year-project," Maina who is also the deputy manager of the project says.
They have raised 2.75 million US dollars from Food and Agricultural Organisation, FAO, International Development Agency, IDA, United Nations Development Programme, UNDP, and <-/Finish> International Development Agency, FINIDA, who have <-/channeled> the funds through the World Bank.
"Our first concern is to undertake short term measures which will contain the current emergency of the aphids problem," he says.
But they also want to research on the biological management approach against the aphid which he says may offer a more lasting solution than the chemical approach.
The latter involves the spraying of the aphid with chemicals.
"We have realised that the chemical approach may not be the long-lasting solution," he says.
They now want to introduce a natural enemy or predator - a wasp from Europe, where the cypress aphid is native. But this will only be effected when enough research has been done on it and its effects here. He says Europe has no problem with the cypress aphid because there is a natural way of getting rid of it there through the predator.
Chemical application has its own constraints in that the aphids could build resistance after a while and also could lead to accidental poisoning of people, animals and fish.
The chemicals are also very expensive.
Foresters have been using the chemical Ambush because the chemical is environmentally friendly.
But what are the chances of the predators wiping the aphids?
Maina relates a similar situation in 1983 when black pine aphids invaded South African forests from the USA. "Two years later they reported a victory over the aphid". 
Nutrition: Milk needed for muscle development
Did you know that if you do not eat calcium rich foods you could develop a bone disease. This disease is known as osteoporosis. Osteoporosis is a disorder characterised by a decrease in total bone mass (without a change in chemical composition). This disease develops silently without pain symptoms. People with osteoporosis have bones that break easily. They may develop hunch backs and may get shorter.
Nearly all people suffer some bone loss as they grow older and it can cause serious fractures. This shows how expensive it is by obtaining enough calcium throughout the early and middle life.
Unlike other nutrients (like salt) which are in excess in most diets, calcium intake is not too abundant and the emphasis is to increase. A lot of people tend not to understand the need to have foods from the milk group, others seem to have some wrong information about milk and milk products.
With a chronic dietary deficiency of calcium the bones are depleted of calcium to supply the body fluids (such as blood) with enough calcium. Among functions of calcium is that it is essential for muscle action and it therefore, helps to maintain heart beat.
As for the calcium in bone, it plays two important roles. The first is to serve as a bank to prevent alteration of blood calcium concentration. Secondly, as most of us are aware, calcium in the form of bones holds the body upright and serves as attachment points for muscles, making motion possible.
Osteoporosis in older people may have multiple causes, but inadequate storage of calcium during the growing years is a factor always in the back ground. This fact under scores the importance of prevention. Plenty of milk while you are young to have healthy bones in later life.
A lot of adults believe that "milk is just for kids" who are still growing and developing bones. However, this is not the case for your bones are alive throughout your life. After your teens, your bones stop growing in length and width, but they still grow in density. Whether they get thicker and stronger or thinner and weaker, depends a lot on you.
Each day, the adult body loses calcium from its bones. If you eat calcium-rich foods, you give your body the calcium they need to maintain or build their strength.
If you don't supply your body with calcium, the bones get thinner and weaker as calcium in the bones is drawn out. That's why milk and other dairy products are important for adults.
Some people believe that without eating dairy products they can consume enough calcium. It is true that calcium is found in almost every food but to get the same amount of <-/calciums> in one glass of milk, you would need to eat 10 eggs, 15 slices of bread, or 1 1/4 cup of cooked green leafy vegetables. Therefore, milk remains the best source of calcium.
A third mistake people make is that of taking black tea or coffee with sugar in the name of watching their waistline. In this case, it would be important for you to realise in weight control, the goal is to reduce the total calories intake without reducing the nutrients. Nutrients are basic to good health, and after all you can select low fat milk and milk products, as the calcium content remains the same.
Some people also trust "pills" to provide them with a day's supply of calcium. The amount of calcium recommended for the daily diet is so great that it will not fit in a single pill that can be easily swallowed. To make it absorbable (or usable by the body), it is combined with a large organic salt which makes it bulky. To get a day's supply you may need to take eight pills that might each be the diameter of a shilling and the thickness of five. It is also important to remember that a calcium pill would not supply other nutrients that are supplied by the milk group.
Another myth people have about milk is that if they drink plenty of milk, they will get kidney stones. These people need rest assured that milk and other calcium-rich foods do not cause kidney stones. Normal adults can consume as much calcium as is found in eight glasses of milk per day.
It is true that some people have problems digesting milk. If you get indigestion (diarrhoea) when you drink an entire glass of fresh milk try:-
* other foods from the milk group like <-/yogurt> or cheese.
* try butter milk or sour milk. 
* eat sandwich with cheese, or soup with milk.
* drink milk in smaller amounts at a go and preferably with meals.
Therefore, do not be a victim of milk misinformation. 
Kidneys and the food you eat
Some people may not know the relationship between kidneys and diet. Yet the kidneys are vital organs. Without functioning kidneys, a single meal upsets your whole metabolic balance. Metabolism is the physical and chemical changes occurring in the body. It includes food digestion.
Some important functions of the kidneys are: 
* Maintenance of composition and volume of the blood 
* Regulation of osmotic pressure 
* Regulation of electrolytes such as sodium (salt) potassium and <-/maintaing> water balance.
A normal kidney produces urine in normal volumes and concentration. This permits elimination of excess water and solutes such as salt and other by-products of food metabolism. An example is urea which is a by-product of protein break-down. Kidneys also eliminate substances that would otherwise be toxic to the body. Only the liver exceeds the kidney in its metabolic activities.
Due to the crucial role of the kidney - regulating body fluids, conserving nutrients, water and excreting waste products - it is not surprising that renal or kidney diseases affect every system and tissue in the body.
Let us look at the nutritional care of various kidney ailments. Renal diseases may be acute, sub-acute (latent) or chronic. They may also have many causes.
Disorders affect <-/matabolism> of nutrients and their by-products. There may be decreased renal clearance of urea, sodium (salt) potassium, mineral elements mostly prevalent in fruits, and calcium mainly found in milk and milk products. There may also be inability of the kidney to conserve nutrients such as protein.